Private Health Insurance Claims Lead - Medical Case Manager

Monroe Consulting Group; Jawa Barat; Sur place; IDR 200 000 000 - 400 000 000; Plein temps

Résumé du poste

Monroe Consulting Group, an Executive Recruitment firm, partners with a Healthcare organization in Indonesia to hire a Medical Case Manager. This role oversees medical claims management, insurance verification, and operational excellence across a hospital network.

The successful candidate will lead claims processing, coordinate with physicians and private insurers, ensure regulatory compliance, and drive performance improvements to minimise rejections and revenue leakage.

Qualifications

• Medical Doctor qualification is mandatory.
• Experience in medical case management, medical claims review, insurance verification, or related healthcare function.
• Experience in private hospitals, hospital groups, health insurers, or TPAs preferred.
• Willing to be based in West Java.

Responsabilités

• Oversee private health insurance claims across hospital units for accuracy and timely submissions.
• Review medical records and docs to ensure private insurer compliance.
• Perform medical necessity reviews to assess service appropriateness.
• Coordinate with physicians, medical services, and hospital admin for docs.
• Liaise with insurers and TPAs on verification, pre-authorisation, letters.
• Monitor pending and disputed claims; identify root causes and fix issues.
• Develop standardised claims procedures across hospital units.
• Guide hospital teams on documentation and submission requirements.
• Analyse claims performance and suggest improvements to reduce leakage.
• Collaborate with corporate and hospital teams to align clinical, finance, insurance.
• Ensure compliance with healthcare regulations and internal procedures.
• Prepare regular reports on claims performance and outstanding items.

Connaissances

Analytical skills

Communication skills

Problem-solving

Detail-oriented

Process standardisation

Stakeholder management

Team collaboration

Formation

Medical Doctor (dr.) qualification

Description du poste

Monroe Consulting Group, an Executive Recruitment firm, partners with a Healthcare organization in Indonesia to hire a Medical Case Manager. This role oversees medical claims management, insurance verification, and operational excellence across a hospital network.

The successful candidate will lead claims processing, coordinate with physicians and private insurers, ensure regulatory compliance, and drive performance improvements to minimise rejections and revenue leakage.